The APTP is designed specifically to address
the patient care and risk management concerns of non-urban
organizations and corporations. The program was first
offered in 1998 and has grown to include eight advanced
first aid protocol modules. These modules meet specific
needs not currently met under conventional training programs
available to non-paramedical responders.
They include:
Pain
Management - Entonox (Nitrous Oxide) Protocol
Fracture Management - Sager Traction
Splint Protocol
Anaphylaxis Management - Epinephrine
& Benadryl (Assist) Protocols
Shortness of Breath Management - Salbutamol (Assist) Protocol
Cardiac Chest Pain Management -
Nitroglycerin & ASA (Assist) Protocols
Cardiac Arrest Management - Automated
External Defibrillation (AED) Protocol
Advanced Airway Management - King
LT Protocol
Multiple Casualty Incident Management &
Triage Training
Pain
Management - Entonox( Nitrous Oxide) Protocol
In the past non-urban responders were
unable to provide any means of pain relief. This is no
longer the case. Entonox has become an important component
of overall patient management and, in many industries,
the standard of care. Entonox (nitrous oxide + oxygen)
is a safe, non-invasive and potent analgesic.
Specific uses may include pain
management during:
- Re-alignment of fractures &/or
dislocations
- The splinting process
- Transportation over rough and
difficult terrain
Entonox is a benign and effective
medication that responders can administer to help reduce
the level of anxiety and discomfort in their patients.
It significantly reduces the emotional impact on patients,
caregivers and bystanders by assisting with rapid splinting
and transport, which is critical to the successful outcome
of a non-urban injury.
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Fracture Management - Sager Traction Splint Protocol
One of the most frequent injuries that non-urban responders
deal with are long-bone leg fracture. Very often, definitive
pre-hospital management requires immobilization with a
constant, measured traction. Historically, maintaining
traction in this manner in the field has been all but
impossible and patient outcomes have been consequently
compromised. The Sager Traction Splint provides this essential,
measured and uninterrupted pull on the axis of a leg fracture
in a simple and expedient manner. The benefits of traction
splinting may include:
-
Reduction of pain.
-
Prevention of secondary injury
due to over-riding bone ends.
-
Restoration of circulation and
sensation and reduction of blood loss.
-
Support and immobilization.
-
Reduction or prevention of serious
complications and disability.
-
Greater patient care / customer
service.
Due to these benefits,
the Sager Traction Splint has become an essential item
in the non-urban responders' tool kit. Its proven effectiveness
in our increasingly litigious society has established
it as the medical and legal standard for leg fracture
management.
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Drug
Protocols - An Introduction
Anaphylaxis (life-threatening
allergic reaction), acute Shortness of Breath (due to
asthma) and Cardiac Chest Pain (angina or heart attack)
can occur anywhere and at any time of year in otherwise
healthy, active people. Most individuals with these conditions
have been previously diagnosed and carry with them the
medications necessary to manage their acute episodes.
However, occasionally these people lose or forget their
medication and rely on the EMS system to provide the needed
treatment in order to survive. In non-urban settings these
patients do not have the time to wait for EMS or EMS is
simply not available to them.
These three modules (the "Anaphylaxis Management", "Shortness
of Breath Management" and the "Cardiac Chest Pain Management"
Protocols) provide the non-urban responder with the knowledge
and confidence necessary to quickly identify a patient's
needs and to determine if, when, and how to address them.
These protocols increase the level of patient care by
educating the responder as to when it is appropriate and,
just as importantly, when not to use the medications.
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Anaphylaxis Management - Epinephrine & Benadryl (assist)
Protocols
Anaphylaxis is a severe whole-body allergic reaction following
an exposure to an allergen. Common allergens include insect
bites/stings, foods, environmental substances and drugs/medications.
Anaphylaxis occurs frequently in the non-urban environment
and is a life-threatening medical emergency that requires
immediate treatment. The only immediate and effective
treatment available is the combination of Epinephrine
and Benadryl.
People with known severe
allergic reactions often carry with them an Epinephrine
auto-injector, however, in non-urban environments these
medications are frequently forgotten or not carried due
to a perception of inconvenient bulkiness.
It is also important to
note that the effective duration of Epinephrine is only
20-60 minutes, and of course extrications and evacuations
from the non-urban environment often take much longer
than that.
Anaphylaxis has a very
poor prognosis without prompt and ongoing treatment. Therefore,
additional medication is usually required during rescues.
Fortunately, symptoms typically abate with appropriate
treatment and this underscores the importance of appropriately
trained and equipped responders.
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Shortness of Breath Management - Salbutamol (assist) Protocol
As discussed above, remote locations can be particularly
unforgiving when onebecomes acutely ill. One condition
that is treatable by non-urban responders is Asthma. Asthma
is a disease of the respiratory system wherein the airways
constrict, becoming inflamed and narrowed with excessive
amounts of mucus - often in response to one or more environmental
triggers. Examples of these triggers include exposure
to an environmental stimulant or allergen, cold or warm
air, dry or moist air, exercise or exertion, or emotional
stressors. Between acute episodes ("asthma attacks"),
most patients feel well; however, affected individuals
may suffer life-threatening episodes characterized by
severe shortness of breath.
These "attacks" (or exacerbations)
can be effctively treated in the field with Salbutamol
(commonly known as Ventolin). Salbutamol is a benign bronchodilator
which, in extreme situations, provides the necessary intervention
and time to evacuate a patient from the non-urban environment
to advanced care for definitive treatment.
Not unlike anaphylaxis, severe asthma attacks left untreated
can result in death, again reinforcing the need to have
staff trained to deal with these potentially life-threatening
medical emergencies.
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Cardiac
Chest Pain Management - Nitroglycerin & ASA (assist)
Protocols
Another condition that non-urban responders are encountering
with increasing frequency is coronary artery disease.
It has no age limitations and no gender bias. Cardiac
patients are being continually encouraged to exercise
and remain active; however, with that advice comes the
risk of exacerbations in remote locations. Consequently,
non-urban responders are being faced with treating acutely-ill
cardiac patients more frequently than ever before. Patients
experiencing cardiac chest pain require immediate medical
attention and this protocol gives the non-urban responder
both the knowledge needed to recognize a cardiac event,
as well as the tools necessary to treat these patients
who might otherwise suffer permanent damage to their hearts.
Cardiac chest pain is most
commonly caused by a diminished supply of oxygen to the
heart muscle. Nitroglycerin relaxes the blood vessels
to the heart thus allowing more blood to flow to the area
of the heart that is being oxygen starved.
ASA has been indicated
by Health Canada for use during acute angina and heart
attacks. If administered within the first hours following
a cardiac event, ASA may reduce a person's risk of fatality
by nearly 25 percent. ASA works by reducing the tendency
of blood platelets to form the clots which typically cause
the blockage of arteries during heart attacks.
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Cardiac Arrest Management
- AED Protocol
Sudden cardiac arrest (SCA) is the leading cause of death
among adults. Every minute a person remains in cardiac
arrest, survivability is reduced by 10%. The definitive
treatment for ventricular fibrillation (the most common
"treatable" type of cardiac arrest) is defibrillation.
Early CPR in conjunction with defibrillation increases
survival rates by nearly 50%.
The increased time required
for paramedics to respond to remote locations, have a
significant impact on cardiac arrest patients' outcomes.
It is clear that a victim of SCA has little or no chance
of surviving in that environment without immediate advanced
treatment. However, new technology (AED - Automated External
Defibrillation) has made the previously exclusive skill
of defibrillation now available to non-paramedic staff
for use in a safe and effective manner.
We are now seeing SCA patients
in the non-urban environment surviving as a result of
non-urban responders provided defibrillation.
Peak is the leader in non-urban
Public Access Defibrillation (PAD) implementation in British
Columbia, and we provide the required medical direction
for the Cardiac Arrest Management (CAM - AED) component
of our Advanced Emergency Medical Training Program. Peak
aims to provide a simple and cost-efficient approach to
the management and organization of a corporation's CAM
- AED program.
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Advanced
Airway Maintenance (BLS) - King-LT Protocol
While it is tempting to think that rapid transport of
patients from remote and non-urban areas can resolve most
emergency problems experienced there, it is simply not
the case. Effective basic patient care must be provided
and maintained during prolonged and difficult evacuations.
As the distance and time involved in evacuation increases
with the remoteness of the event, so increases the need
for higher levels of training and treatment in order to
keep seriously injured and ill patients alive until advanced
life support is available. Effective airway management
has been identified as the most crucial factor in survival
during rescues from non-urban areas.
It is difficult to provide effective bag-valve-mask ventilation
in an emergency room; how much more so when packaging
and transporting a patient in an often hostile environment?
Therefore it is critical
for non-urban responders to have a means of confidently
providing a secured airway and reliable ventilations during
extrication and treatment, as well as during packaging
and evacuation, in order to ensure the most favourable
outcome possible.
Immediate, effective airway
management is the cornerstone of good patient care - the
"A" of the ABC mantra highlights its necessity. There
are many advantages of definitive pre-hospital airway
care, including the delivery of high concentrations of
oxygen, the prevention of gastric distension, and the
protection of the lungs from the aspiration of emesis,
to mention only a few.
The King-LT is the safest
and most reliable disposable supraglottic airway tool
for pre-hospital emergency airway management and ventilation
when endotracheal intubation is not feasible or available.
Studies indicate that, when the King-LT is used, the development
of gastric distension (and consequent vomiting / aspiration)
is reduced by as much as 95% when compared to the use
of the bag-valve-mask on its own. In addition, the King-LT
has been engineered to withstand extreme environmental
conditions, and takes literally only seconds to insert
-- which makes it a most suitable airway management device
for the non-urban environment.
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Multiple Casualty Incident Management & Triage Training
(MCI)
Most first aid programs discuss the concept of triage
management; however, they generally focus on the context
of a two or three patient incident at a very theoretical
level. The MCI Program offered by Peak is a high-level
one-day course where participants are expected to take
a global perspective of much larger accident scenes.
The program reviews the
standard Incident Command organizational structure that
is used during large-scale incidents. This review explains
each Responder's duties, how to manage available resources
(people, equipment and agencies), and of course, how to
classify individual patients for treatment priority (triage).
After the review, a mock disaster exercise provides the
student with a hands-on opportunity to actively implement
the theory. All the skills gained from this exercise are
equally applicable to smaller scale scenarios as well.
Much of the course content is integrated directly to the
corporation's emergency plan and teaches the practical,
effective implementation of this plan.
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These training programs are an essential investment
in the preparedness of your rescue team. They empower
your team to intervene in life-threatening situations
in which they would otherwise be powerless.
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